Reducing harm, saving lives

People struggling with addiction need support, not stigma

This year marks the 50th anniversary since President Richard Nixon declared the War on Drugs. The U.S. continues to reckon with the failed "tough-on-crime" policies that have led to harsh treatment, over-sentencing and the disproportionate incarceration of people of color. Meanwhile, service providers in central Illinois say the best way to keep people struggling with addiction safe is to meet them where they are, to provide help based on their most basic needs. That's part of the theory behind "harm reduction" – policies and strategies to help people struggling with addiction in a way that avoids some of the risks associated with drug use by preventing overdose and addressing other needs.

JOLT Foundation is an Illinois nonprofit that provides education and supplies related to harm reduction. The organization has a mission based on human rights and health care for everyone. JOLT has outreach teams based in Peoria and provides what's called "wraparound" support, which can include providing access to resources like shelter, food, health care and employment.

Addiction is considered a behavioral and mental health condition that requires support and treatment. Using terms like "addict," "clean" or "dirty" dehumanizes the condition and is stigmatizing, according to harm reduction providers and medical professionals who now use the term "substance use disorder" to describe addiction.

Chris Schaffner, JOLT's program director, said helping those with substance use disorder can be difficult, and stigma is one of the hurdles to clear. "When you prove yourself to be a trusted ally ... communities that do not have a voice appreciate the work you do," said Schaffner. "We were one of the only organizations out on the street when the pandemic first hit last year and the needs were overwhelming."

Before COVID-19 drove most people to social-distance, the center focused on HIV and hepatitis C prevention and treatment by offering free on-site tests. The group has since partnered with a mobile health unit that offers clients pop-up prescription refills and an array of first-aid items. This includes tools needed to reduce accidental deaths and infection in Peoria County. JOLT offers clean needles, condoms, bandages, antiseptic wash and a dozen other personal health care items, free of charge. Naloxone, often known by the brand name Narcan, is also offered by JOLT and can be distributed by outreach members. The drug reverses overdoses and can prevent death. Doses can be administered by inhaling a nasal spray or injection.

Building relationships

Staff at JOLT create relationships with high-risk and vulnerable populations. People who are homeless, have substance use disorder or are involved in sex work have specific health needs that have often been neglected. Misinformation and stigma make it harder for harm reduction providers to advocate on behalf of their clients.

People can feel uncomfortable visiting community health centers. Stigmatization can limit the amount of support available to people. It can negatively affect funding and limit outreach efforts.

click to enlarge Reducing harm, saving lives
Credit: Courtesy of JOLT Foundation
The JOLT Foundation outreach team. Chris Schaffner, program director, is located fourth from the left. He stands next to Cecily Johnson, the center’s testing specialist.

JOLT's role in the Peoria area has grown since 2019, particularly during COVID-19, Schaffner told Illinois Times: "There were all these growing needs and we operated through the entire [pandemic]." JOLT worked to get temporary housing for people facing evictions. Schaffner said the group has relied heavily upon social media and word of mouth. Area residents and shelters helped temporarily house JOLT's clients.

JOLT packages and delivers food donations. Other care packages include sanitary and personal hygiene products. The packages include first-aid supplies and a card with JOLT's contact information. Private cash donations have increased around 600% since last January, said Schaffner. The funding has helped JOLT extend its donation program, grow in staff and expand health services.

Increasing needs

In March the Centers for Disease and Control and Prevention (CDC) released a report titled, Notes from the Field: Opioid Overdose Deaths Before, During, and After an 11-Week COVID-19 Stay-at-Home Order. The case study was an analysis of overdose data from Cook County.

The number of overdose-related deaths reported by Cook County doubled from October 2019 to March 2020. On average, 42 people per week overdosed and died during the statewide lockdown in Cook County, according to the CDC report.

click to enlarge Reducing harm, saving lives
Credit: Madison Angell
Rachel King, the clinical outreach and service coordinator at the Phoenix Center, shows how supplies are organized and packaged. Kits that include clean needles and naloxone are delivered to clients in Springfield and the surrounding areas.

At an Illinois Senate health committee on March 30, Illinois Department of Public Health (IDPH) data analyst Leslie Wise reported "concerning" trends regarding overdoses, deaths and synthetic substance use. IDPH estimated the number of fatal overdoses in 2020 increased 30% statewide, compared to 2019. IDPH also estimated the number of overdoses in Illinois attributed to synthetic substance use increased more than 70% in 2020.

Wise warned that fentanyl, an opioid prescribed for pain but also illegally produced, was driving the spike in accidental deaths and non-fatal overdoses. Mixing fentanyl with other substances – specifically methamphetamines – can be extremely dangerous. Harm reduction providers and IDPH are finding traces of fentanyl cut into pressed pills and other substances sold illegally. Fentanyl is less expensive and easier to obtain than other hard drugs, but is more fatal.

Overdose reversal drugs, like Narcan, are available at harm reduction centers and over the counter at many pharmacies. Consistent access to Narcan decreases the need for visits to emergency departments and prevents accidental deaths.

JOLT distributes close to 300 kits each month, with three doses of Narcan in each bag. This is in case more than one dose needs to be administered, which can happen when too much fentanyl is ingested, according to experts like Wise. JOLT has delivered more than 15,000 doses of the overdose prevention drug since the pandemic began.

During the state Senate committee hearing in late March, Wise said the true numbers of overdoses may be even higher. The data is valuable to community-based service providers because it's information about those most affected by the opioid crisis – where they are, who they are – and if they have access or feel comfortable seeking harm reduction services.

Hospitals offering acute care services are required under the state's Hospital Licensing Act to register with a database and report overdoses within 48 hours of delivering treatment. In December 2019, IDPH published a list showing more than 60 facilities failed to comply with the registration or reporting guidelines.

Engagement between response teams and underserved populations has proven to be a successful strategy in areas like Peoria County, where accidental deaths have shown a year-to-year decline. Overdoses – both fatal and nonfatal and exclusively attributed to fentanyl – have decreased since 2017 in Peoria County, where JOLT operates.

According to the CDC and IDPH, fentanyl testing strips are becoming increasingly important as even small amounts of fentanyl can cause accidental overdoses and deaths. Professional training and education to test drugs for traces of fentanyl is encouraged by the CDC and IDPH. JOLT also offers fentanyl testing as part of its services.

Support vs. stigma

Cecily Johnson is a substance testing specialist at JOLT. She said she "loves everything about" her work as a member of the community outreach team at JOLT, where she provides education on substance safety. This includes first-aid and Narcan training and information on alternative ways to use substances, which can reduce the chances of overdosing.

"I love the community organizations we work with, too," she said. Johnson said community engagement and networking is critical to providing services clients most need. "There's nowhere else I can call and say, 'I have a homeless person with nothing,' and by the end of the night he's got a tent, he's got clothes, he's got food and everybody checks in to make sure he has a ride to his job the next morning," said Johnson.

click to enlarge Reducing harm, saving lives
Credit: Madison Angell
Chris Schaffner shows how substances can be tested at JOLT for traces of fentanyl, using packaged strips and a chemical solvent. Fentanyl is a common cause of overdose.

Johnson, after being prescribed opioids earlier in her life, said she developed a substance use disorder. She is now in recovery. "With my lived experience, my crazy hair, my music and my crazy mouth, I think it all makes me more approachable." She said that helps her build trust with clients. "If you're not approachable and informed, you're closed off," she said. "That door that is going to help you build relationships ... if it's shut, the opportunity to engage is lost."

Johnson said she has observed some law enforcement and first responders call JOLT's clients "junkies" and "worthless." One client of Johnson's sought Narcan at a local pharmacy, as a peer overdosed nearby. They were denied access to the overdose reversal drug based on a false premise that they needed a prescription, said Johnson.

Harm reduction providers in Springfield have also felt stigmatized and have faced obstacles in pharmacies. "If I have a diabetic cat and I ask a pharmacy for clean needles, some places still will not give me those needles without a prescription, which is not required by law. Some people give you the attitude and the [bad] look," said Jonna Cooley, director of the Phoenix Center in Springfield. "Now you can only imagine what people who deal with addiction go through on a day-to-day basis," she said.

The Phoenix Center, a nonprofit focused on LGBTQ advocacy and community health, began its harm reduction program with five clients in 2011. Today the center serves more than 700. "A lot of people are against what we do – do not understand addiction or why we do what we do," said Cooley. "It's meeting the very basic needs for people." The Phoenix Center is on track to distribute nearly 500,000 clean needles over the course of 2021. It has also installed a "walk-up window." The space resembles a pharmacist's counter where people can privately access supplies.

As a result of the ongoing opioid crisis, law enforcement in Illinois is required to carry Narcan and officers are supposed to receive training for administration. This has helped police better understand "what it is we do," said Cooley. "It is meeting people where they are and telling each person they are valued," said Cooley. "Now the biggest obstacle we face is the stigma."

Life-saving solutions

The Phoenix Center is grateful for increases in grants from the state and federal government due to COVID-19 relief funding, said Cooley. She said outreach teams are now taking services and supplies on the road. The Phoenix Center serves Sangamon County and surrounding rural areas. "We make sure people have all the supplies they need to stay safe," said Cooley. That includes Narcan kits and on-site training for administering it. Cooley said the harm-reduction program is the largest the Phoenix Center operates and requires the most resources. But it is the least funded of all the programs Cooley oversees. Other programs include housing and health services, youth engagement, LGBTQ event coordination, advocacy and on-site education. "I just don't think there's been a lot of money set aside for harm reduction," said Cooley.

Two years ago, Gov. JB Pritzker signed legislation allowing harm-reduction groups to open needle and syringe exchange programs. This year, Illinois lawmakers considered legalizing "safe consumption sites" – supervised areas where medically trained people make sure people using drugs don't overdose – but it didn't pass. The measure was publicly endorsed by Schaffner at JOLT. Supervised consumption sites have been popular in other parts of the world, but the concept has been slow to catch on in the U.S.

In 2020, Oregon became the first state in the U.S. to decriminalize the possession of all drugs. In 2018, Oregon was also one of the first states to propose legislation that would allow safe consumption sites, which it did again this year, though no state has yet been successful in passing such a law. In 2019, the U.S. Justice Department sued a nonprofit in Philadelphia for running a safe consumption site, contending the practice defies federal law. While those in the field say that they know clinically supervised drug use could save lives, it's unclear when or if lawmakers may come around to the idea.

Madison Angell was the Illinois Times University of Illinois Springfield Public Affairs Reporting intern from January-June of 2021.

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